To reduce the incidence of pressure ulcers, administrators of long term care facilities must identify which care processes need improvement and measure if their management interventions are effective. Currently, this is difficult because the reliability of care delivery is overestimated in patients'charts and medical records. Most of the physical body care of the ill or frail elderly in institutions - especially long term care - is provided by nursing aides and other clinical paraprofessionals. These aides have large workloads, are not often paid well and, hence, have high job turnover rates. It is not easy for clinical management to monitor the reliability of care delivery by aides and since much of the care is done in the privacy of a patient's room where it is difficult to measure the timeliness and duration of care that is actually received. Omitted care is especially problematic for patients with dementia, because many cannot recognize or reliably report when they receive poor care or care is omitted. We are developing a system to conveniently and robustly monitor the timeliness of body care delivery without increasing the work burden of nursing aides and other direct care clinical personnel. During SBIR Phase I we will use a very small, reliable, and low cost wearable body position monitor that can be worn by patients to unobtrusively record various critical kinds of body care. Because we record the care as it is experienced by patients, it supplements medical records based a nursing aides self reporting. There is evidence that such self reporting - whether on paper records or new electronic systems - overestimates the care actually delivered to patients. The focus of our SBIR system development is to automatically document the quality of geriatric care for people over 65 who have mobility impairments, incontinence , and may have dementia, in a manner desired by clinical management and care quality assurance personnel to improve facility care quality. PUBLIC HEALTH RELEVANCE: It is not easy for clinical management in long term care facilities to monitor the reliability of physical body care delivered directly by aides and assistants because much of that care is done in the privacy of a patient's room. This is especially true if the patient receiving the care has dementia and cannot reliably report on care deficiencies. We are developing a system to conveniently and robustly monitor the type, timeliness and duration of physical body care delivered to geriatric patients, without increasing the work burden of nursing aides and other direct care personnel. For Phase I we examine incontinence and repositioning care for pressure ulcer prevention. The data from our wearable monitor based data collection system will be in a form that can be used to facilitate clinical quality assurance and quality improvement programs.